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Anesthesia and Perioperative Care

140.01: ADVANCED CLINICAL CLERKSHIP - Seema Gandhi, M.D.

Tier 1B. UCSF Department of Anesthesia & Perioperative Care offers a 4-week clinical clerkship to provide medical students a perspective on anesthesia resident training, didactics, & research opportunities. This rotation offers a unique insight into the depth & breadth of cases performed at UCSF. The clerkship includes rotating at three sites: 1) Moffitt-Long Hospital: a tertiary referral center for complex neurosurgical, cardiovascular, transplant, pediatric, orthopedic cases. One week is spent in the operating rooms & one week with the regional & pain management services. 2) San Francisco General Hospital (SFGH): the city hospital & level one trauma center. One week spent with residents on night call learning management of trauma care & acute resuscitation. 3) VA Medical Center: One week of cardiac anesthesia.
Course Objectives: I. Acquire the following skills and knowledge: - Describe preoxygenation and develop the ability to mask ventilate a conscious and unconscious patient. - Learn techniques of preventing airway obstruction in the conscious and unconscious patient. - Describe the anatomic or physiologic characteristics that describe a patient who has a difficult airway. - Conduct a preoperative patient interview and physical. - Describe the indications/complications for the following procedures: blind nasal tracheal intubation in the conscious patient, orotracheal intubation in the unconscious patient using direct laryngoscopy, cricoid - Pressure and mask ventilation of the unconscious patient. - Describe the components of anesthesia: amnesia, analgesia, muscle relaxation, control of ANS, sedation. II. Anesthesia and co-existing diseases. - Identify the significant diseases that will impact patients morbidity/mortality. - Assess the adequacy of medical control of pre-existing conditions. - Anticipate intraoperative requirements for monitoring and drug therapy. - Predict perioperative risk based on pre-existing disease and the surgical procedure proposed. For each system: - Cardiovascular: (ie., Coronary artery disease, congestive heart failure, valvular heart disease, arrhythmias - Respiratory: (ie., Upper respiratory infection, asthma, COPD) - Gastrointestinal: (ie., Risk for aspiration, electrolyte imbalance) - Endocrine: (ie., Diabetes, thyroid, adrenal) - Neuromuscular: (ie., Burns, umn lesions, LMN lesions, trauma) III. Pain pathways/perioperative pain management. - Understand mechanisms of pain; both acute and chronic. - Know how to prescribe appropriate medications for patient-controlled analgesia (pca). - Learn the methods available for providing analgesia for the post-operative patient. - Differentiate between pain syndromes which require �specialist� evaluation vs. Those which may be effectively managed by primary care physicians. IV. Anesthesia and concurrent drug therapy: (ie., Psychotropic, anti-arrhythmias, anti-hypertensive, anti-anginal, aspirin/nsaid) V. Special monitoring / technical procedures. (ie., Starting iv's, measuring bp, a-line, capnography, oximetry) VI. Blood therapy and maintaining appropriate fluid balance. - Realize the difference between different types of iv solutions. - During blood loss, appreciate the difference between anemia and hypovolemia. VII. Operating room hazards: - Positioning: understand the factors which make anesthetized patients more susceptible to peripheral nerve injuries. - Hypothermia: etiology, prevention and treatment. - Rare event: malignant hyperthermia, aspiration pneumonitis VIII. Acid base repair and maintenance: - To understand the causes and consequences of acid-base disturbances and how to analyze acid-base abnormalities. - To know the causes of hypoxia. - To understand 02 transport and measure it's adequacy. IX. CPR: to review the principles behind basic and advanced CPR with regard to: - Time of institution of CPR measures. - CPR organization - Airway support - Physical cardiac support - Therapeutic support X. Recovery from anesthesia: - Assess emergence from anesthesia - Assess criteria for tracheal extubation. - Understand common problems in the recovery room - Learn about oxygen therapy and the equipment used to deliver it.
Common Problems/Diseases: Wide range of management issues for both children and adults.
Recommended Text or Reading: Clinical Anesthesiology by Morgan, Mikhail, & Murray, 4th edition. A Lange medical book.
Team Composition: Work closely with anesthesia faculty, fellows and residents.
Patient Contact Hour Number (hours): 40
Classroom Time (hours): 7
Outside Study (hours): 5
Call Schedule/Weekends: Three weeks of M-F daytime. One week of evening and nighttime (off during the day).
Grading: Pass/Fail/Honors
Prerequisites: 2 weeks of Anesthesia experience or completion of Anesthesia/Medicine & Surgery core clerkship.
Quarters Taught: Su 1 & & 3, Fa, Wi, Sp
Location: Unspecified
Minimum Weeks Offered: 4
Maximum Students per Block: 4
Contact Name: Marie Lim
Contact Phone: (415) 476-2851
Location to report to: You will be notified

How to Add & Drop a course:
To add or drop this course, please submit a request through the online elective request system.